Gas administering



June 2, 1936. E. 1. M KESSON I GAS ADMINISTERING 6 Sheets-SheetFiled/122mb 132 9.

14 7 a9 M5 4 j June 2, 1936.

E. l. M KEssoN' GAS ADMINISTERING June 2, 1936. I MCKESSQN 2,042,474

GAS ADMINISTERING Filed March 10, 1930 e sheets-sheet 5 June 2, 1936. EMCKESSON 2,042,474

GAS ADMINISTERING Filed March 10, 1930 e Sheets-Shet 4 June 2, 1936. E.MCKESSON' 2,042,474

GAS ADMIN I STEERING Fil ed March 10, 1950 6 Sheets-Shegd 5 June 1936-E. l. M KEssoN ,474

GAS ADMINISTERING Filed March 10, 1950 I 6 Sheets-Sheet 6 Patented June2, 1936 UNlTED STATES PATENT OFFICE GAS ADM INISTERING son, Toledo, OhioApplication March 10, 1930, Serial No. 434,587

1 Claim. This invention relates to gas administering.

This invention has utility when incorporated v in apparatus for checkingthe condition of a patient and administering gas to the patient, moreparticularly in association with features for disclosing facts in regardto the patient and as to the gases.

Referring to the drawings:

Fig. 1 is a side elevation with parts broken away of an embodiment ofthe invention in a machine for cutting down high pressure gas supply andconducting such to a patient;

Fig. 2 is a detail view on an enlarged scale in plan of the relief valveat the mask;

Fig. '3 is a plan view of the apparatus of Fig. 1, parts being brokenaway;

Fig. 4 is a section on the line IV-IV, Fig. 2;

Fig. 5 is a front View of the apparatus of Fig. 1 from the left, withthe delivery duct and vaporizer removed;

Fig. 6 is a section on the line VI-VI, Fig. 3;

Fig. 7 is a section on the line VII-VII, Fig. 3;

Fig. 8 is end view from the right of the section of Fig. 7, parts beingbroken away and the cover plate being removed;

Fig. 9 is a section on the line IX-IX, Fig. 6;

Fig. 10 is a section on the line XX, Fig. 3;

Fig. 11 is a partial section on the line X[ fl, Fig. 10;

Fig. 12 is a detail view from the inner side of the nitrous oxidchamber, with parts broken away;

Fig. 13 is a section on the line XIIIXIII, Fig. 12;

Fig. 14 is a section on the line XIV-XIV, Fig. 3; and

Fig. 15 is a section on the line XV-XV, Fig. 10.

Casters i are shown as mounting spider 2 carrying column 3 havingbracket 4.

Nitrous arid-oxygen High compression gas supply tanks 5, 6, may beclamped by bolts '1 in heads 8 having valves 9 operated so that throughcoupling ID the high pressure gas may be stepped down by reducing valveor regulator M as adjusted by screw or bolt l2 and held by clamp bolt ISin arm M of the bracket 4 (Figs. 1, 5).

The column 3, extending above the bracket 4, mounts head I5 having armsl6, [1. The arm It has duct I? thereto from the regulator II as incommunication with one of the nitrous oxid tanks 3 extending to fittingl8 (Figs. 3, 5). The regulators it, shown as provided with a pair ofcouplings it, permit simultaneous assembly of two tanks therewith sothat as one tank is depleted the other tank may be cut in and the supplythrough the duct l1 not interrupted. The exhausted tank may be replacedand this accordingly provides operation facilities for the 5 region overan extended interval even with small tanks.

The fitting I8, for the'guidance of the operator, is shown as havingnotation l9 thereon. In the instance herein shown this is nitrous oxidas the 10 anaesthetizing gas. This fitting I8 is in communication withpassage (Fig. 10) in the arm is. From this passage 20 extends duct 2| togage 22 (Figs. 3, 5, 12) for disclosing the pressure of the gas deliveryas cut down by the nitrous 15 oxid regulator l l which may be say tofifty or sixty pounds, while the pressure at the tank may haveoriginally been a number of atmospheres, say 3000# per square inch. Inlieu of the auxiliary, or duplication of the tanks at the valve or 20regulator H, one of the couplings l0 may be connected to a high pressuregage 22 (Fig. 3) so that the amount in the supply tank may be checked,and when so checked as the supply becomes reduced, the auxiliary newtank supply attached, before the depression gets down below that atwhich it is desired to keep the pressure as indicated by the gage 22.

The passage 20 has branch-23 having terminal port 2t in proximity toflexible rubber diaphragm 25 (Figs. 1213) providing chamber 26 havingoutlet passage 27 therefrom to depending tube 28 spilling intodistensible chamber 29 of disk form about the tube 28. This chamber 29is thus provided with a pair of parallel distensible diaphragms 36, 3|.Housing plate 32 is protection and distension limit means for thediaphragm 3|, while opposing plate or housing section 33 is for thedistensible diaphragm 30 of the chamber 29. w

Delivery pressure adjustment The diaphragm 30 is shown as having insertmetal plate 34 as a bearing for nose 35 of bent lever 33 (Figs. 5, 13)protruding through opening 31 in the housing section 33. The lever 36has fulcrum bearing 38 in the arm is with short arm 39 upward therefromengaging reduced end 40 of plunger 4i directed by guide 42 against thediaphragm 25 as a holding means for causing the lever 35 on distensionof the chamber 29 to cuted gas supply to the chamber 29 by way of theport 24.

From the reserve or pressure supply tank 5 as connected '(Figs. 1, 3, 5)through its reducing valve ll, supply of oxygen by way of duct 42 is thecommunication between the supply and the machine. This oxygen supply iseffective through duct 20 in the arm I1 and discloses the oxygenpressure as passing the reducing valve at gage 44. The control of oxygengas delivery at the reduced pressure to the oxygen chamber below theoxygen gage is analogous to that to the nitrous oxid chamber below thegage 22.

From the levers 36, as oppositely directed toward opposing diaphragms 39is intermediate pair of links 45 having pivot pin connection 46 (Figs.3, 5, 6). These links 45 thus provide a toggle from which there extendsa yieldable resistance herein shown as comprising sleeve 41 havingclosure plug 49 as an abutment for compression helical spring 49 in thecylinder 41.

This spring 49 is oppositely held by pin 50 through stem 5I emergingpast the plug 48 with clearance 52 for lateral play. This stem 5|extends through forwardly projecting arm 53 of the head I5. This arm 53for this stem 5| has clearance way 54. The upper portion of this stem 5Ihas threaded portion 55, with which engages pinion nut 56 in mesh withpinion 51 on stem 58 fixed with knurled indicating disk 59 as disposedadjacent pointer 60 (Figs. 3, 6) on housing having hold-down portion 6|precluding axial shifting of the pinion 56. The knurled indicating disk59 is shown as having notations 62. Accordingly, in rotating this disk59 say for lifting the pin 51 by the operation of the nut 56 thereon,compression of the spring 49 is increased and there is accordingly atendency to pull up the toggle pin 46 and resultantly increase theresistance to contraction which the lovers 36 might have.

There is thus a building up of the operating pressure in the chambers 29as effective for gas supply, which is of a pre-determined indicationdisclosed at the notation 62 and this notation is to the extent of fullycutting off the supplies of the gases herein disclosed as nitrous oxidand oxygen in coming to the automatic delivery valves at thepredetermined reduced pressure which may be the millimeters of mercuryabove atmosphere below the range which is that for rupturing the lungs,say up to forty millimeters of mercury.

Proportiom'ng From the chamber '29 and about the passage 20 is dischargeport 63 (Fig. 13) to passage 64 (Figs. 10, 15) in the arm I6. Thispassage 64 extends to port 65 centrally of the head I5. Here is centralseat 66 for hollow plug valve 61 having port 68 movable to variableregister with port 65 thus providing communication with chamber 69 onone side of partition 10 in the plug valve. This plug valve is providedwith ledge 1I flush with the top of the partition '10 providing a seatfor check disk 12 by gravity normally providing a closure for thechamber 69. V

This plug valve above the disk 12 has chamber 13 in which. is mountedbushing 14 carrying transparency 15 held therein by gasket 16 and sleeve11 depending into the chamber 13 as -a limit stop for the rise of thecheck disk 12.

The oxygen delivery from the oxygen chamber29 is to passage 18 in thearm I1 (Figs. 10, 15) with flow to port 19 oppositely from the port 65as to partition 10 of the plug valve 61. This plug valve 61 has thereinstepped or tapered port narrower at the lower proportions and wideningup for greater width of port opening as the proportion increases foroxygen flowing through the ports 19 and ports 80 as brought intoregister in chamber 8| below the check disk 12 of the one-way gas flowvalve.

From this chamber 13 are lateral ports 82 (Figs. 6, 11) to deliverypassage 83 in the arm 53 of the head I5 for conducting the flow of gasfrom the two pressure sources of supply at the reduced pressure asseparately coming to the valve 61 and together passing from up about theperiphery of the valve 12 into the chamber 13.

The proportioning of these two different gases is effected by rotationof the plug valve 61 in its seat 66 in the head I5. This plug valve asprotruding above the head I5 adjacent the bushing 14 has overhangingflange 84 (Figs. 1, 3, 6, 10) carrying scale 85 indicating percentage ofoxygen as in position relatively to the pointer 60. The arm 53 has stoppin 86 with which pin 81 at the flange 84 coacts at the zero position ofoxygen or 100% nitrous oxid, while the pin 86 coacts with pin 88 on theflange 84 as a stop at the 100% position of oxygen or zero nitrous oxid.As heretofore indicated, the zero oxygen and zero nitrous oxid isobtained by adjusting the dial 62 to on position at the pointer 60.

Micrometer operation or more delicate adjustment of the knurled flange84 may occur in this proportioning, in lieu of handling this diskreadings on the scale 85 as disclosed by the pointer there isproportional rotation of the plug valve 61 and nicety of proportioningto a minor percentage may be determined and this gas is accordingly, asdefinitely proportioned, free to pass from the chamber 13 (Fig. 10) byway of the passage 83- (Figs. 6, 11). Fitting 96 may provide themounting connection for flexible duct 91, terminating in fitting 98(Fig. 1) having rigid mask section 99 carrying flexible mask rim I00, asa delivery nozzle to the patient by placing such over a respiratoryorifice, as the nose or nose and mouth, in order that upon inhalationthere may be such drop in pressure that the check disk 12, as gravityseating, will be poised for supply of the nitrous oxid and oxygen gasesin the predetermined proportion to the patient. Upon exhalation thecheck valve 1 seats and the gas supply is cut off.

Relief 7 In the mask fitting 98 (Figs. 1, 2, 4) is branch bushing IOIterminating in seat, I02 against which rests check disk I03 as held bycompression helical spring I64. Threaded with the bush- I08, atprotruding push button portion I I4 there- 75 of, materially increases"the resistance of the spring I04 and accordingly in practice is anormal closure for the check disk I03 against spilling of exhalation bythe patient. In normal operation, the spill may be adjusted as to backpressure by rotating the shell IIZ which is provided with inwardlyextending or thread means I I5 coacting with helical external groove II6 on the extension sleeve I05 fixed by pin I05 with the fitting 98. Bythe rotation of the shell II2 relatively to the sleeve I05 the clearancebetween the collar I09 and the spider I06 is reduced and thereisincreased compression of the spring I04. Calibration marker or pointer'I I1 is provided on the housing 98 with scale II8 on the shell H2 sayin steps of five millimeters of mercury up'to twenty, or other pressureas desired,thereby determining the exhalation pressure at which thevalveI03 may be unseated for spill of exhalation from the patient.

Rebreathing of the suppliedgases do not get into the lungs for taking upby the system of the patient and are exhaled uncontaminated. Otherportion of the exhalation includes the gases given up by the patient,say carbondioxid as well as inert gases rejected. Importance attachesnot only to conserving the supplied gases for anaesthesia and oxygen formaintaining life activities, but there is purpose in the carbon dioxidas an excitant to respiratory action. Herein measure is taken to effectreturn of exhalation gas in advanceof any re-supply of nitrous oxid,oxygen, or other gases, thereby insuring that the carbon dioxid of theprevious exhalation may get to the patient for promoting a degree oflung action desired.

To this end the duct 83 is in direct communication through the ports 82and chamber 13 with passage II9 (Fig. 6) in the arm 92. This passage II9extends to gusseted chamber I as a rebreathing bag or reservoir inshield or housing having section I 2! toward the column 3 and fixed withthe head I5 and additional section I22 on pivot bearing I23 adjacent themounting of the flexible or distensible chamber I20 with the arm 92.

halation, cut off by check va1ve'12 from getting therebelow in the plugvalve, flows through the passage II9 to inflate this chamber I20 andthus swingthe arm I22, as depending, outward on its fulcrum I23. Thischamber I20 is accordingly collapsible and distensible over a range.This range in practice as adopted herein may be 1200 cc. or a rangebeyond the tidal volume usually experienced with patients. This chamberis thus responsive for filling, and upon inhalation, is responsive foremptying.

Hereunder, as an important feature of handling the patient, there may beattained effective emptying of the chamber I20 before the check valve 12lifts for further supply of gases to the patient. This advance expulsionor emptying of thechamber I2 0 is effected by loading mechanism hereinshown as involving cam I24 on the shield section I22. Roller I25 ondepending arm I26 rides on this cam I24 to approximate uniform pressureas the shield I22 swings outward during the inflation of the chamber I20. This 'arm. I25 is engaged by end I21 (Figs. 6, 9) of torsion springI28 about'shaft I 29 which has fixed terminal connection I30 with collarI3! fast on this shaft I 29. This shaft I29 is under hood. or housing I32 and terminally protrudes in shield I33 (Fig. 3) to house worm wheelI34 (Figs. 8, 9). Worm I35 is in mesh with this worm wheel I34 and maybe operated by key I36. 5 The angle of friction is sufficient to holdthe worm I35 in the adjusted position, while the operation of the keyI36 is effective for increasing or decreasing the torsion action of thespring I28.

This means that this rebreathing chamber I20 may be adjusted to open ata pressure which in practice is desirably just below and effective inadvance of unseating valve disk I03 at the mask. The shield I33 (Fig. 3)is provided with 15 pointer I31 fixed therewith in the vicinity ofwindow I38; Fixed with the worm Wheel 5534 is scale I39 movable in theoperation of the key I36 past the window I38for disclosure by thepointer I31 as the resistance, say in millimeters of mercury, againstinflation of the chamber I23, which may thus be visibly checked with.the adjustment at the relief valve.

Rebreathing volume adjustment 25 side cheeks I41. Handle I48 may begrasped and 35 swung clear of the ratchet I for the attendant to locatethe stop I4I in-desired positions for maximum inflation of the chamberI20.

Rebreathing volume disclosure The housing I32 above the shaft I29carries bracket I49 (Figs. '7, 9) mounting shaft I50. Loosely mounted onthis shaft I59 is arm I5I carrying scale I52 disclosed through windowI53 (Fig. 3) of the housing I32. Additionally, also 45 loosely mountedon the shaft I50, is pointer I54 protruding through-the window I53 todisclose a reading on the scale I52. Compression helical spring I55between these loose arms I5I and I 54 and about the shaft I50 interposesa frictional resistance for retaining location of this scale I52 asadjusted by handle I56 and for the pointer I54 disposed to be engaged bysupplemental pointer I51.

The supplemental pointer I51 is also loosely mountedon the shaft I50 asan angle lever and carries short arm I58 (Fig. '1) connected by link I59to bracket I60 mounted on the depending swinging shield section I22aboutthe chamber I20 movable in response to inflation of such chamber.It thus follows that this inflation movement of thechamber I20 istransmitted to shift the pointer I51 along the scale I52 to pick up thepointer I54 at the maximum range of shifting during the inflation, andas the chamber I20 is emptied or deflated the pointer I51 recoversleaving the pointer I54 to show on the scale I52 the volume in 100 00.,an instance herein disclosing rebreathing permitted say at theadjustment of the stop I40. I

i For checking full tidal volume of the patient, the head 'I I4 may bedepressed to hold the relief valve from opening and the pawl I43 clearof the ratchet I45. Preferably this may occur with a minimum of pressureas'applied bythe key I36,

although it may be at the operating pressure as determined for thepatient. At this aeidialation, the pointer I51 is effective say inshifting :irom zero on the scale I52 up to the .range of the :exhalationvolume. This carries the pointer 154 so that it is not encumbent uponthe operator to watch for the pointer 151, for the pointer I54 will restat this tidal volume limit.

In the operations hereunder, the adjustment of the scale I52 by thehandle I56 permits the location of the zero point on this scale at thedeflation' or emptying position of the chamber I20 as the minimum beforere-inflation.

Emergency oxygen Threaded on this bushing I63 is cap I61 hold- 7 ing thediaphragm. I66 in position, this cap having a central opening I68therethrough. Push button I69 protrudes through this opening I68 and haswithin the cap I61 enlargement I10 bearing on the diaphragm I66oppositely to the head- I65. Depression of this push button I69 iseffective through stem I'1I to thrust fiber seat I12 away fromclosureposition at the port at the lower end of the bushing I6I. This thrustingof the push button I69 as transmitted to this seat I12 .in collar I13 isresisted by compression spring I14 normally holding this port closed. Itfollows from this depression of the push button I69, unseating of thevalve I12 allows the high pressure oxygen from the passage 26 to howpast the bushing I6I about the stem I1 I into passage I15'to dischargeby port I16 through ports 82 (Figs. 10, ii) in the plug valve for thishigh pressure oxygen supply, not only to pass above the disk 12, butflow directly through the passage 83 as a lung inflating spurt to thepatient directly responsive to the pressure of the push button, with cutoff at once the pressure is released at such push button I69.

Carbon diorid In lieu of rebreathing or as a definite supplementalsupply for anaesthesia or excitant,carbon dioxid as an additionalminorgas volume may be supplied say from pressure cylinder I11 past'reducing valve or regulator I18 to flow throughduct I19 to fitting I80(Figs. 1, 3, 10), provided with seepage port I8I at phenol condensationproduct seat and tapered valve I82 having scale notation I83 movable asto pointer I84. This scale as disclosed, say with the carbon diox'idpressure .at sixty pounds will give the direct reading of say 100 00.;300 cc, and 500 cc. per minute spill past this seepage port I 8I, toflow from this fitting 180 by branch duct" I8 5 by-passing the oxygenemergency-for direct fiow into the passage 175 and thus forintermingling with the delivered or tenance of the accuracy for thisminor volume supply as continuous and collateral which is spilled to thepatient direct at the adjusted rate.

supplemental mthesiayns "In parallel with or in heu of nitrous oxid,ethylene may he used, and to this end adjacent the fitting I8 bearingthe notation "I9, there is provided .fitting I8 bearing ethylenenotation I86 as a supply to the passage 20 in parallel with or in lieuof the nitrous oxid supply from the duct I1. The ethylene supply to thefitting I8 may be from pressure tank source through reducing valve orregulatorand thence by flexible duct I81.

vaporizer Additional supplemental anesthesia promotion may be from avaporizer liquid source as "ether. For such, there is shown hereinintroduced in the duct 83 'by coupling 188 head I89 '(Figs. 1, 3, 14) ofvaporizer. This Thead I89 is provided with ether cup or chamber 190which may have charge I9I of ether therein. The head I89 is providedwith flange I92 carrying a pair of depending concentric'foraminmlscylinders I93, I94, as a housing for fiber J95 serving as a capillaryattraction means for increasing the vaporizing surface of ether -I9I.The cylinder I93 is spaced inward from the outer portion of the cup .190and the inner cylinder 19! leaves clearance for central chamber 196.

The head I89 .is provided with scale I9] adjacent slot 198 through which,protrdues handle I99. This .handle as operating along this scaledetermines the ratio of .gasflow to be by-passed from the direct .flowbetween the passages and '61 into this ether cup. This .is efifected bysleeve 200 to which the .handle I99 is directly connected and throughwhichsleeve this handle extends to anchor partition 201. This sleeve asrockable in the head 189 has ,port 20-2 on the supply side forregistering with port 203 of the head I89 .in communication above theflange I92 .forflow of gas .to pass .into the cup I through the outerforaminous cylinder I93 over the ether impregnated fibrous material. I95thence out through the foraininous cylinder I94 .into cylinder I96. Asthus charged with ether vapor it flows upward through duct 204 and port205 into head I89 throughport 206 in the sleeve 200 on teh opposite sideof the partition '20I from the port 202, as an ether pregnated chargingportion of the anaesthetizing gas.

This head I99 at the 0d posit-ion has the port 202 clear the port 203and in register with port v201 in the head 189 (Fig. 3) for by-passingthe ether cup by way of passage 208 and port 209 in register with thesleeve port 296 of the sleeve 200. It accordingly follows from theintermediate positions as indicated by the handle I99 on the scale I91,the ports 202 and 2060f the sleeve 200 are in partial register forsplitting the gas flow between the ports 203 and 201 for entering andbetween the ports 206 and 209 as passing on to the patient.

In operation, the patient .to be subjected to the anaesthesia has themask I-00 applied after a supply tank for each of the :gases to be usedis opened up and tested out through the machine, with .all foreign-gasesthus removed and the.

' mask has been subjected to inhalations and exhalations to operate thevarious valves for delivery and exhaust or relief. The mask I00 is thenapplied to the patient.

practice it is usual to ailowinitialiy a few heavy or high percentageinhalations of the anaesthetizing gas, :say the nitrous 'oxid; Then themachine is adi-usted say by manipulating the disk 81 to that percentagewhich seems to be adequate to hold the patient in the desired conditionof anaesthesia or analgesia. At each inhalation the check disk 12 islifted after the rebreathing bag I20 has collapsed. On exhalation, thecheck disk 12 first is seated, the bag I20 is then distended to thedesired quantity for rebreathing, and thereafter the relief valve diskI03 at the machine opens for exhaust.

The operation of the rebreathing bag in advance of the new gas supplyhas a tendency to keep the respiration excitant carbon dioxid in suchvolume in the circuit as to promote the respiration cycle. With thepurpose of increasing progressively the accumulation of the carbondioxid, the moments when respiration becomes to be progressivelydecreasing in volume, the carbon dioxid valve disk I83 may be operatedfor delivery directly into the machine in advance of the new gas supplyand continuously at desired flow rate.

This carbon dioxid affords a stimulation means for keeping therespiration normal as to rate and o1 an efiicient depth in the lungs. Asthere is desired recovery, this supplemental gas supply of carbon dioxidmay be cut out. Otherwise hereunder as the mask is removed from thepatient there is not fresh gas delivery, only as there may be buildingup' of pressure through the manipulation of the disk 59.

What is claimed and it is desired to secure by 16 Letters Patent is:

A gas administering machine comprising an intermittently distensiblerebreathing chamber providing a responsible replenishment device for thechamber, and means for adjustably establishing resistance to fillingsaid chamber by said device embodying a plate member, pivotal mountingmeans for the member and adjustable loading means for the memberrockable to and fro by the action of said member.

ELMER I. MCKESSON.

CERTIFICATE OF CORRECTION.

Patent No. 2,042,474. June 2, 1956.

ELMEE I MOKESSON.

It is hereby certified that error appears in the printed specificationof the above numbered patent requiring correction as follows: Page 5,second column, line 14, in the claim, for the word "responsible" readresponsive; and that the said Letters Patent should be read with thiscorrection therein that the same may conform to the record of the casein the Patent Office Signed and sealed this 18th day of August, A. D.1956.

Henry Van Arsdale (S l) Acting Commissioner of Patents

